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I think we've established that health insurance rates have gone nuts, health care reform has gotten some people covered who couldn't get it before, but from my side of the desk, there are still problems that need to be worked out. So along comes SB 562, and all you need to do is get rid of the greedy insurance companies, let the state take over, and then it will all be fine--really?

I was at a town hall meeting weekend before last sponsored by a couple of our local state legislators who think this is the way to go. The current estimate before even getting started is $400 billion, which is more than the entire state budget. Where will that come from? Well, keep in mind that if this bill passes, the intent is that it will replace ALL health insurance in the state--plans from employers, individual health plans, MEDICARE, MediCal, TriCare, Children's Health plan and even the regional centers that help the developmentally disabled. The intent is that they (the appointed, not elected, board who will run this) will then work to secure waivers for all federal programs to have the funding rerouted to the tune of $200 billion to help pay for this. Good luck with that.

The remaining estimated $200 billion will come from thee and me--there is talk of a 15% payroll tax, 2.3% sales tax, a gross receipts tax of 2.3% on business making more than $2 million a year and who knows what else. But that's okay, because we won't be paying insurance premiums. Hhhmmm....what about the people that aren't paying them now? The estimated cost per person is $9200--not per household, per family, but per person. I have a tough time believing that Washington DC is going to grant the re-routing of Federal funding to start a new program, but I'm no clairvoyant.

And all of this is without truly knowing the cost of the plan ultimately. How are doctors and hospitals going to be paid? If it's based on Medicare or god forbid, MediCal rates, physicians are already not happy with that, so good luck. And the way the plans are proposed to be structured, there will be no deductibles, no copays, just go and be taken care of. That's not going to cost a fortune is it? Keep in mind, 'free' is very expensive--read on.

At this town hall, there were representatives from the California Nurses Association who are strongly behind this. There was one impassioned woman who was convinced that the study they commissioned would save around $37 billion, because we're already spending $368 billion, and by getting the middle man out of the way, doctors and nurses would be able to just take care of people without 'red tape,' seeking authorizations, and dealing with bureaucracies. That's when I had to step away. So, I guess she's saying they can do whatever, whenever? I'm a nurse, I'm still licensed as an RN, and this isn't my first rodeo. Do you know why insurance cost went up over time? Cost of care went up over time, and then there's fraud--insurance on all fronts has it, whether it's private insurance or Medicare/MediCal. Who's going to be watching that? And Page 7 of this study said, they can't account for everything, basically this is an educated guess. 85 pages of educated guessing. Not to slam it, but it's not THE definitive explanation of how it will work. It's an educated guess, haven't we had enough of those?

Okay, I've been MIA as far as writing articles because things have been busy, including me getting married. But the prospect of SB 562 passing in our state has made me shake the dust off my writing.

SB 562 is proposing a 'single payer' system--this means the State of California would be paying the bills. NO more insurance companies, no more private insurance, individual or group health benefits. Or Medicare. Or MediCal. The current cost estimate is about $400 billiion a year, which is about double the entire State budget. Where is that going to come from? Well, part of it, according to the authors of the bill, would come from the existing funding from the Federal Government for Medicare and MediCal. Really? That's a stretch, as the Feds would have to sign off on that, so who knows. That would account for about $200 billion of the funding, the rest would need need to come from taxes. Great.

There are many facets to this concept, so there will be more articles coming soon. Two terms that are interchanged, incorrectly, are 'single payer' and 'universal coverage.' They are not synonymous. Single payer means one entity writes the checks, universal coverage means everyone's covered, or able to be covered, but there could be more than one 'payer.' So in theory, with the Affordable (?) Care Act, we have universal coverage, everyone has access to coverage but not everyone buys it. We still need to deal with affordability, which the ACA hasn't necessarily done.

SB 562 was passed in the Senate yesterday, now it goes to the Assembly. It's a flawed bill, another one of those 'pass it, then we can work out the details' kind of thing. Sound familiar? I watched some of the hearing yesterday, and support and opposition pretty much fell along party lines. But there were a couple of Dems who really pulled a fence straddler, in my opinion. They talked about the flaws in the bill, how incomplete it was and how 'ordinarily' they wouldn't vote for something like this but they like the general concept and there still needs to be a conversation on the subject. So this way, no matter what happens, feels like they can proclaim victory for their vote. Oh geez!

Of course then there is the little discussed hidden secret, that more Dems are against it than are willing to admit it. They are presuming Gov. Brown will veto it, that's their safety net. So they can appear to be for it, then be protected from the fall out if the Governor vetoes it. Keep in mind, this is the same State Legislature that had a bill a couple of years ago that would require all legislators to buy through Covered California, the health insurance exchange, and it didn't even make it out of committee, it crashed and burned before it could go for a vote. Talk about hypocrisy! Here's a link to an LA Times article yesterday about what this could mean for consumers. It's not completely unbiased of course, but we 'have to start the conversation.' Read article

Good question--One
of the industry experts I heard speak on a conference call a couple of weeks
ago said that anything around repeal is going to require 60 votes, and there
are 2 chances of that happening--slim and none, and slim just left town. So the
best we can hope for is amending, fixing, the existing law. Personally, I'd be
okay with that, depending on what the fixes are.

Trump’s plan included serious cuts to Medicaid, aka MediCal
in California. That’s a problem since about 30% of the state is on MediCal.
There was some talk of revamping the premium rate structure, from a 3:1 to a
5:1 ratio—currently the highest rates cannot be more than 3 times the lowest
which is part of what drives rates up for younger people, because health care
costs for those of us for ‘a certain age’ are higher.

Plan designs need to be revised also—the Gold level and
especially the Platinum level are for the most part are unsustainable, they
cost a LOT to maintain. And not everyone wants all the bells and whistles
included with the new designs.

So what happens to subsidies, plan designs,
eligibility—time will tell. Hopefully calmer heads will prevail.

I have people ask me this everyday--Now that Trump has been elected President, what's going to happen to our health insurance? Is it going away, is it going to get more expensive, is it going to get less expensive? Are the subsidies going away, are we going to single payer?

Right now, nobody knows. The chant of 'repeal and replace' isn't entirely practical. This is going to take planning, it's not going to be something fixed, corrected or changed by Tweets. Rather than rehash a bunch of stuff, I ask that you check out this article which is an interview with Robert Laszewski, a highly respected expert, and what he thinks will, could or should happen. Read article.

Take a few minutes to read this, it will give you some insight, and hopefully calm the concerns that it's all going away the day Trump takes office.

In a word, NOTHING. It's November 9th, day after THE election. Sun came up, most birds were still singing, but as far as health insurance and the god awful rates we're looking at for 2017, nothing will change right now.

First of all, Trump doesn't take office until January. When he does I hope he will have been spending a lot of time on building teams to look at many areas, especially health care and how to fix the Unaffordable Care Act. In case he or any of his team catch my blog, I have some opinions of what could help. And no, I don't have the stats to back how much could be saved, or insurance costs could be cut--this is just gut instinct:

Modify the 'actuarial values' structure--this is where the law says a Platinum plan has to cover 90% of your costs, Gold covers 80%, Silver covers 70% and Bronze covers 60%. This needs to be modified, especially the Gold and Platinum levels, because these structure are unsustainable. Gold and Platinum plans usually have no deductible. Great, but that makes these plans really expensive.

We used to have plans that would offer generic drug coverage only. Government said that wasn't good enough. But what if that's all you wanted, and you were willing to chance it? Shouldn't that be your choice? That would help.

Maternity coverage is required on all plans. And to the guys that say 'they' don't need it, 1. you're usually involved when a woman gets pregnant, and 2. I have coverage for prostate exams I don't need. I would like to see it permissible to have a few plans without Maternity coverage, but require carriers to have it on the majority of their plans, like 75-80%--that spreads the cost out, otherwise plans with maternity are ridiculously expensive.

Revamp the exchanges--how did they expect to add a whole NEW bureaucratic layer in health insurance administration and bring the cost of insurance down? Shrink the exchange concept down to where they help administer/answer questions about that kind of eligibility. Agents at least in California have been involved in the majority of insurance plan sales on Covered CA. Maybe expand their ability to answer questions about the MediCal side, since it's 'hands off' for them once one is eligible for MediCal and the case goes to the 'Local County Office'--yikes!